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At least 307 records · Page 17Linked to original sources
PubMed1997

MR arthrography of the glenohumeral joint.

This article explores MR arthrography of the glenohumeral joint, including normal anatomy of the glenoid labrum, glenohumeral ligaments, and biceps labral complex. Examples of glenohumeral joint instability include the Bankart lesion, anterior labroligamentous periosteal sleeve avulsion, glenolabral articular disruption, humeral avulsion of the glenohumeral ligament, and Bennet lesion. Normal variations include the sublabral foramen, the Buford complex, and cord-like middle glenohumeral ligament. Labral tears and paralabral cysts are also discussed.

Humans↗
PubMed1985

The roentgenographic evaluation of anterior shoulder instability.

Retrospective evaluations of roentgenograms of 83 patients with unilateral shoulder instability were surveyed to evaluate the usefulness of various radiographic projections and to correlate the information with the osseous pathology associated with prior glenohumeral dislocation. The Hill-Sachs and the osseous Bankart defects were considered pathognomonic radiographic signs of glenohumeral joint instability. Based on history, physical examination, and examination under general anesthesia, patients were divided into three categories--(1) dislocation group, (2) subluxation group, and (3) combination group. Roentgen projections evaluated included the anteroposterior view with the humerus in internal and external rotation, axillary view, West Point view, Stryker notch, and Didiee view. The Hill-Sachs defect on the posterolateral aspect of the humeral head was best demonstrated on the combination of an internal rotation and a Stryker notch view. The osseous Bankart defect on the anteroinferior glenoid rim was best documented on the Didiee and West Point views. The external rotation and axillary view did not add significantly to the preoperative radiographic findings. In a patient with an unstable shoulder, a radiographic series that includes an internal rotation, a Stryker notch view, and either a West Point or a Didiee view would maximize the diagnostic yield per radiographic cost, time, and exposure.

Adolescent↗
PubMed2004

[Therapeutic options in the treatment of cartilage defects. Techniques and indications].

BACKGROUND: Cartilage is composed of chondrocytes embedded within an extracellular matrix of collagens, proteoglycans, and noncollagenous proteins. Together, these structures maintain the unique mechanical properties and manifest its striking inability to heal even the most minor injury. METHODS: This review presents the principles of cartilage structure and the biological background of cartilage repair and gives information about the surgical techniques for treating cartilage defects. RESULTS: The response of cartilage to injuries differs from that of other tissues because of its avascularity, the immobility of chondrocytes and the limited ability of mature chondrocytes to proliferate and alter their synthetic patterns. Surgical therapeutic efforts in treating cartilage defects have focused on bringing new cells and tissues capable of chondrogenesis into the lesions and facilitating the access to the vascular system. CONCLUSION: The right indication and the treatment of joint instability and axis deformation are essential for the successful use of cartilage repair procedures.

Cartilage, Articular↗
PubMed2000

Hill-Sachs type lesion of the femoral head in a case of hip instability.

A Hill-Sachs lesion of the shoulder is an indicator of shoulder instability. Hip instability is also a well-recognized phenomenon. However, no operative or arthroscopic features have previously been reported that support the diagnosis of hip instability. We present a case report of a Hill-Sachs type lesion of the femoral head in a patient with acetabular dysplasia revealed by arthroscopy of the hip. We suggest that finding a Hill-Sachs type lesion of the femoral head may also be regarded as indicative of joint instability, just as it is in the shoulder.

Adult↗
PubMed2001

[Experiences with Eaton-Littler reconstruction for therapy of ligament instability of the thumb saddle joint].

UNLABELLED: Painful instability of the thumb carpometacarpal joint is a rare diagnosis. Between October 1995 and August 1999, eight operations of ligament reconstruction for unstable thumb carpometacarpal joints were performed. We report on the follow-up of these patients which took place at an average time of 12.27 months (range 5 through 36 months) after the operation. Painful hypermobility of the non-arthrotic thumb carpometacarpal joint was the indication for performing the operation in all cases. By this operation, the joint capsule is reinforced in two planes: the existing palmar ligament of the carpometacarpal joint is reinforced while it provides ligament support for the radial aspect of the joint that is otherwise membranous. In our study, we compared the pinch strength, the overall strength of the hand, the motion of the thumb, and radiographic findings for the amount of subluxation before and after performing the operation. In addition, each result was investigated with the DASH-questionnaire (DASH = Disability of Arm--Shoulder--Hand). The results were good or excellent in six cases, satisfactory in one case, and poor in one case. Pinch strength increased from a preoperative average of 19.6 N to 34.3 N and the vigor increased from 84.8 N to 113.1 N. Subluxation on the radiographs could be reduced from an average of 6.0 mm to 3.5 mm. All operated patients were investigated using the DASH-questionnaire. Herein the average score was 22.92 on a scale whereby 0 reflects minimum and 100 maximum disability. CONCLUSIONS: Our experience with the Eaton-Littler procedure for stabilisation of the hypermobile painful thumb carpometacarpal joint were mostly positive. The objective results as well as the results of the evaluation of the DASH-questionnaire could confirm this impression.

Adolescent↗
PubMed2005

Trapezius transfer in brachial plexus palsy. Correlation of the outcome with muscle power and operative technique.

Between March 1994 and June 2003, 80 patients with brachial plexus palsy underwent a trapezius transfer. There were 11 women and 69 men with a mean age of 31 years (18 to 69). Before operation a full evaluation of muscle function in the affected arm was carried out. A completely flail arm was found in 37 patients (46%). Some peripheral function in the elbow and hand was seen in 43 (54%). No patient had full active movement of the elbow in combination with adequate function of the hand. Patients were followed up for a mean of 2.4 years (0.8 to 8). We performed the operations according to Saha's technique, with a modification in the last 22 cases. We demonstrated a difference in the results according to the pre-operative status of the muscles and the operative technique. The transfer resulted in an increase of function in all patients and in 74 (95%) a decrease in multidirectional instability of the shoulder. The mean increase in active abduction was from 6 degrees (0 to 45) to 34 degrees (5 to 90) at the last review. The mean forward flexion increased from 12 degrees (0 to 85) to 30 degrees (5 to 90). Abduction (41 degrees) and especially forward flexion (43 degrees) were greater when some residual function of the pectoralis major remained (n = 32). The best results were achieved in those patients with most pre-operative power of the biceps, coracobrachialis and triceps muscles (n = 7), with a mean of 42 degrees of abduction and 56 degrees of forward flexion. Active abduction (28 degrees) and forward flexion (19 degrees) were much less in completely flail shoulders (n = 34). Comparison of the 19 patients with the Saha technique and the 15 with the modified procedure, all with complete paralysis, showed the latter operation to be superior in improving shoulder stability. In all cases a decrease in instability was achieved and inferior subluxation was abolished. The results after trapezius transfer depend on the pre-operative pattern of paralysis and the operative technique. Better results can be achieved in patients who have some function of the biceps, coracobrachialis, pectoralis major and triceps muscles compared with those who have a complete palsy. A simple modification of the operation ensures a decrease in joint instability and an increase in function.

Adolescent↗
PubMed2001

Clinical and gait-analytical results of the modified Evans tenodesis in chronic fibulotalar ligament instability.

The present paper describes the medium-term results (mean follow-up period 3.01 years) achieved after surgical stabilisation of 79 patients using modified Evans tenodesis. The follow-up examination included a questionnaire for rating the subjective sense of stability, a clinical examination, stress X-rays, a modified 100-point score according to Zwipp, and kinetic gait analysis. Although joint instability was significantly improved in the radiological stress images, only 73.4% of the patients subjectively rated the stability achieved as excellent or good, compared with satisfactory in 22%, and even poor in 3.8%. In the overall result of the 100-point score, 51.9% of the patients achieved a very good, 35.4% a good, 11.4% a satisfactory, and 1.3% a poor result. Radiologically, an increase in the rate of arthrosis was verified in 17.4%. Significant deteriorations in mobility were observed for the supination. The kinetic gait analysis revealed statistically significant differences compared with the non-operated side for step length (P < 0.05), relative step length (P < 0.05), and in the symmetry of heel-to-toe movement (P < 0.005). The modified Evans repair can restore the mechanical stability of the ankle, but it leads to impaired kinematics of the ankle, with subjective and functional restrictions and radiologically detectable degenerative changes. For this reason, modified Evans tenodesis should only be performed if anatomically orientated stabilisation operations are not possible.

Adolescent↗
PubMedDate not supplied

Surgical treatment of the unstable ankle.

Symptomatic ankle instability will develop in as many as 20% of patients after inversion sprain of the lateral ankle ligaments. Although most patients may be successfully treated with a rehabilitative exercise program and bracing, some will continue to sustain recurrent ankle sprains with activities of daily living, work on uneven terrain, or sports. The anterior talofibular ligament and the calcaneofibular ligament are the primary stabilizers of the lateral ankle, and surgical procedures should be aimed at restoring the normal function of these ligaments. Preoperative stress radiographs should be obtained to determine the degree of laxity and to differentiate between subtalar joint and ankle joint instability. Numerous surgical techniques have been described to correct ankle instability, most with an 80% to 90% success rate. Reconstructions using tendon grafts may restrict normal ankle and subtalar joint motion, depending on the placement of the graft. Direct repair of the anterior talofibular and calcaneofibular ligaments with shortening and reattachment to the fibula has a success rate similar to that for augmented reconstruction and avoids the increased morbidity associated with tendon graft procedures. Patients with severe laxity or with weak or deficient tissue for direct repair may require an augmented reconstruction. Osteotomy may be required in addition to ligament reconstruction in patients with severe ankle or hindfoot varus alignment, in order to prevent failure of the repair. Patients with paralysis or weakness of the peroneal musculature may require a nonanatomic procedure that limits subtalar motion.

Ankle Joint↗
PubMed1991

[The mechanism of the development of residual deformation and complications after the reduction of congenital hip dislocation in children and their conservative treatment].

There is described the mechanism of development of hip joint instability of different types and associated secondary complications. Conservative biomechanical approach of treatment of residual instability and its complications: enchondral growth and ossification, delay, pathologic restructuring and coxarthrosis, is proposed.

Adolescent↗
PubMed1999

Glenohumeral joint range of motion and rotator cuff strength following arthroscopic anterior stabilization with thermal capsulorraphy.

STUDY DESIGN: Single-session, posttest only, descriptive analysis of range of motion (ROM) and strength. OBJECTIVES: To measure ROM and strength approximately 12 weeks following arthroscopic anterior stabilization of the glenohumeral joint with thermal capsulorraphy. BACKGROUND: Treatment of the patient with anterior, unidirectional glenohumeral joint instability often includes surgical stabilization. Current methods focus on arthroscopic stabilization and early ROM and strengthening to restore normal function to the upper extremity. METHODS AND MEASURES: Twenty patients diagnosed with unidirectional shoulder instability (mean age 24.5 years, SD = 8.48) underwent a postoperative rehabilitation program following unilateral arthroscopic shoulder stabilization with thermal capsulorraphy. Objective testing including ROM and isokinetic internal rotation (IR) and external rotation (ER) strength at 90, 210, and 300 degrees/s was performed 12 weeks postoperatively. RESULTS: Ten patients had a complete return of shoulder flexion ROM at 12 weeks. There were deficits compared to the noninjured extremity in postoperative glenohumeral joint mean abduction (9.8 +/- 12.7 degrees), IR (8.4 +/- 15.0 degrees), and ER (13.1 +/- 14.4 degrees). Isokinetic testing showed a complete return of ER strength on the postoperative extremity compared to the uninjured extremity for 12 patients with a 4% (+/- 21.1%) mean deficit measured in IR strength at the slowest testing velocity. No significant difference was found between extremities in the external/internal rotation ratios. CONCLUSION: Postoperative rehabilitation emphasizing progressive ROM and rotator cuff and scapular strengthening has produced favorable results in patients 12 weeks postoperatively with respect to glenohumeral joint ROM and IR and ER strength. Further research and follow-up is required to obtain long-term outcomes with respect to patient satisfaction and stability of the glenohumeral joint following this arthroscopic procedure.

Adult↗
PubMed2006

Distal fibular length needed for ankle stability.

BACKGROUND: The fibula is commonly used for bone grafts. Previous clinical and biomechanical studies have suggested that the length of the residual portion of the distal part of the fibula has an important effect on the long-term stability of the ankle joint. However, we cannot find clear-cut guidelines for the amount of bone that can be harvested safely. METHODS: Using six normal fresh-frozen cadaver legs, motions of the tibia, talus and calcaneus were measured. The fibula was cut sequentially 3 cm from the proximal tip of the fibula and distally 10 cm, 6 cm, and 4 cm from the distal tip of the lateral malleolus. The angular motion of each bone was measured while a medial and lateral traction force of 19.6 N was applied to the proximal tibia. Angles of the tibia, talus, and calcaneus were measured. RESULTS: Sequential resection of the fibula increased the inversion angles of the ankle joint. The proximal 3-cm cut increased the inversion angle from 42.1 +/- 6.2 degrees to 49.6 +/- 3.6 degrees, and the distal 4-cm cut increased the angle from 57.6 +/- 6.6 degrees to 67.4 +/- 5.9 degrees. The rotational angles were almost constant with sequential resections of the fibula; however, the distal 4-cm cut increased the rotational angle from 11.3 +/- 25.1 degrees to 78.7 +/- 37.5 degrees. CONCLUSIONS: The whole fibula including the head is essential for the stability of the ankle joint complex, and the distal fibula is responsible for stabilizing the ankle mortise during external rotation and inversion. We recommend fixation of the syndesmosis or bracing to prevent ankle joint instability with rotation of the talus in the mortise, especially when the distal fibula is shortened 6 cm or more.

Aged↗
PubMed1985

Biomechanical analysis for osteoarthritis of the ankle.

The study of three-dimensional model of the human arthritic ankle joint by the stress freezing photoelastic technique showed regional increases of stress distribution in contact area of the medial side of the talocrural joint and medial shift of the stress distribution center in the subtalar joint. From the study of the ankle joint in a contact stress analysis under a variety of conditions, the possible cause of primary or secondary osteoarthritis is discussed, and the joint instability resulting from lateral collateral ligament injuries might be one of the major cause of the disease. For the treatment of the disease, low tibial osteotomy with ligament plasty is considered to be effective.

Ankle Joint↗